Fundamentals of Health Workflow Process Analysis and Redesign

1. Fundamentals of Health Workflow Process Analysis and Redesign Unit 10.1a The Concepts of Health Care Processes and Process Analysis

2. Procedure, like dance, resists description. -- Tom DeMarco 1979

3. Topics – Unit 10.1 • Role of Health Care Workflow Analysis and Redesign Specialist • Definitions • Healthcare Roles and Responsibilities • IOM 6 Quality Areas • Importance of HIT to Health Care - Meaningful Use Second Lecture starts here • The Clinical Setting • Common Health Care Processes • Clinical Workflow • Summary: What a Process Analysis and Redesign Specialist Does

4. Unit Objectives Upon successful completion of this unit the student is able to: • Describe the purpose for process analysis and redesign in the clinical setting • Describe the role of a workflow process analyst and redesign specialist and contrast it with other roles such as technical support and implementation management • Explain how health process analysis and redesign and meaningful use are related • Analyze a healthcare scenario and identify the components of clinical workflow • Given a scenario of a health care analysis and redesign, analyze the responsibilities of each participant in the process and how the roles complement or overlap with one another • Describe how the workflow processes used by a healthcare facility might differ depending on the type of facility

5. Definitions Definitions: • Process • Process Analysis • Process Redesign • Workflow • Workflow Analysis • Data, Information, and Knowledge • Data and Information flow

6. Process a series of actions or operations conducing to an end a continuous operation or treatment process. (2010). In Merriam-Webster Online Dictionary.Retrieved July 17, 2010, from http://www.merriam-webster.com/dictionary/process

7. Process Analysis • understanding process elements and the relationships between them • AND • identification of opportunities for improvement

8. Process Redesign The revision of a process to improve it in some way.

9. Workflow … “the flow of work” … The way in which work progresses, including order of steps and selection between alternative steps.

10. What is Clinical Workflow? • Workflow is an established business process describing how the tasks are done, by whom, in what order and how quickly • Workflow is defined as the coordination of tasks, data, and people to make a business process more efficient, effective, and adaptable to change

11. Workflow Analysis • understanding workflow elements and the relationships between them AND • identification of opportunities for improvement

12. Data, Information and Knowledge Data: a difference Information: data + meaning Knowledge: justified true belief • Declarative knowledge • Procedural knowledge

13. Data and Information Flow the steps or path by which data are moved through a work process or a system or some combination of both, including the order of steps, and operations performed on the data (or information)

14. A Workflow Process Analyst and Redesign Specialist combines • Understanding of an organizations objectives, structure and procedures, and • Knowledge of how to exploit information technology to improve how an organization operates and achieves it’s goals

15. Role of Health Care Workflow Analysis and Redesign Specialist Workers in this role assist in reorganizing the work of a provider to take full advantage of the features of health IT in pursuit of meaningful use of health IT to improve health and care.

16. Process Analyst Role • Describe the Dance • Overcome communications problems in analysis • Natural difficulty in describing procedure • Inappropriateness of narrative text for describing procedures • Lack of common language between the user and analyst

17. Process Analysis Skills • At ease with data and data system concepts • At ease with clinical workflow concepts • Able to communicate such concepts • Able to identify problem areas

18. Process Re-design • Role: Choreographing a new dance between humans, information, and computers • Skills: Ability to combine organizational knowledge and technology to create a better way

19. Why is Health Care Process Analysis and Redesign Important? • 98,000 or more people die annually in the US due to medical errors3 • Lack of information and care fragmentation called out as leading contributors2, 3, 4 • Meaningful use of Health IT will decrease this number 4

20. Process Analysis Involves • understanding process elements and the relationships between them • AND • identification of opportunities for improvement

21. IOM 6 Quality Areas • Safe • Effective • Efficient • Timely • Patient centered • Equitable

22. EHR Meaningful Use • Term coined by the framers of the American Recovery and Reinvestment Act of 2009 (ARRA) • Addresses five national health policy priorities

23. 5 National Health Priorities • Improve quality, safety and efficiency and reduce health disparities • Engage patients and families • Improve care coordination • Improve population and public health • Ensure adequate privacy and security protections for personal health information (PHI)

24. Meaningful Use Topics • Data Capture • Data Standards • ICD, SNOMED, RxForm, LOINC • Effective Clinical Workflows • Computer-based Order Entry • E-Prescribing • Clinical Decision Support • Patient Health Information Exchange • Privacy and Security • eMAR (Medication Administration Records)

25. Meaningful Use RequirementsExamples • >= 80% of all orders directly entered by authorizing provider • >= 75% of all permissible medication orders are electronically prescribed • . . .

26. Meaningful Use Requirements Tougher Each Year 2009 2011 2013 2015 HIT-Enabled Health Reform Meaningful Use Matrix (07/17/2009) 2011 Meaningful Use Criteria (ElectronicallyCapture/share data) 2013 Meaningful Use Criteria (Advanced care processes with HIT decision support) 2015 Meaningful Use Criteria (Improve Outcomes Using HIT) 26 2010 Final Rule MU (07/13/2010) ARRA (02/17/2009)

27. References • DeMarco, Tom. Structured Analysis and System Specification. Yourdon Press, Prentice-Hall, New Jersey 1979 • To Err is Human: Building a Safer Health System 1999 available from the National Academy Press (NAP) at http://www.nap.edu/books/0309068371/html/ • Crossing the Quality Chasm: A New Health System for the 21st Century 2001 available from the National Academy Press (NAP) The full text of this report is available at http://www.nap.edu/books/0309072808/html/ • Willam W. Stead and Herbert S. Lin, editors; 2009 Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions,Committee on Engaging the Computer Science Research Community in Health Care Informatics; National Research Council available online at http://www.nap.edu/catalog/12572.html • Medicare and Medicaid Programs: Electronic Health Record Incentive Programat https://www.cms.gov/InpatientPsychFacilPPS/Downloads/CMS1306Pdisplay.pdf

28. This concludes the first of two lectures for the Concepts of Processes and Process Analysis unit. You may go on to the second lecture or stop and return to the second lecture at a later time.